| NPI | 1003073388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD438710) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD438710) |
| 208600000X Surgery (Licence: PA MT 184375) | |
| 208600000X Surgery (Licence: WV 31756) | |
| 2086S0129X (Licence: WV 31756) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2024-08-02 |